A common infectious pathology in pregnant women is pyelonephritis. Knowing the alarming symptoms and understanding the health risks motivates you to promptly seek qualified help and minimize the likelihood of adverse consequences.
Concept and classification of the disease
Pyelonephritis (from the Greek “pielos” - pelvis, “nephros” - kidney) is an inflammation of the kidney tissue caused by infectious pathogens of a bacterial nature.
It is customary to divide pathology according to several criteria:
- Process intensity:
- acute and chronic.
- Order of occurrence:
- primary (infection occurred in a completely healthy urinary system);
- secondary (there is a disturbance in the flow of urine, for example, expansion of the ureter, its abnormal course, etc.).
- Changes in urine flow:
- obstructive (accompanied by blocking the passage of urine through the ureter with a stone or purulent masses);
- non-obstructive.
- Number of affected organs:
- unilateral (one kidney suffers);
- bilateral (both are involved).
- Severity of the disease:
- complicated (with acute renal failure, arterial hypertension, sepsis, etc.);
- uncomplicated.
Acute pyelonephritis is observed in 5% of pregnant women, often preceded by asymptomatic excretion of bacteria in the urine. If pregnancy occurs against the background of remission of chronic pyelonephritis, the risk of exacerbation is extremely high. Within 6 weeks after birth, the threat gradually decreases.
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Dangers and Risks
Due to the peculiarities of the immune response, during pregnancy, pyelonephritis poses a threat to the life of the woman and baby:
- in the first trimester - the risk of spontaneous abortion is significantly higher, in the second and third - premature birth;
- after 20 weeks - there is a risk of gestosis, and its persistent, long-term, severe course is more often noted;
- the development of intrauterine infection, malnutrition and even fetal death at any stage.
There are 3 levels of risk:
- I degree - pathology appears for the first time and proceeds without complications;
- II degree - the chronic form of the disease was present before pregnancy;
- III degree - complicated pyelonephritis or pyelonephritis of a single kidney.
A breastfeeding woman is at risk of infection breast milk is minimal, but due to the additional load on the body, complications are more common.
With secondary pyelonephritis, the risk of an unfavorable course and the need for surgical treatment is always higher than with primary one.
Doctor Elena Berezovskaya about pyelonephritis - video
Causes of pyelonephritis in pregnant women
The following pathogens are most often identified in pregnant women:
- Escherichia coli (Escherichia coli);
- staphylococci and streptococci;
- chlamydia;
- ureaplasma;
- herpes simplex virus;
- cytomegalovirus.
Proteus, Klebsiella, fungi are found with less frequency, and very rarely - Epstein-Barr virus and Trichomonas.
In 22%, a combination of several pathogens is determined, and in 15% they cannot be detected, since the bacteria transform into special “protected” L-forms.
It is customary to highlight several possible ways entry of infectious agents into kidney tissue:
- ascending - from the urethra up the urinary tract;
- hematogenous - bacteria and viruses can be delivered through the bloodstream from anywhere in the body - carious teeth, sore throat or ear, etc.;
- lymphogenous - similar to hematogenous, but transmission of the pathogen occurs through lymphatic vessels.
Features of the functioning of the body during the period of bearing a child predispose to kidney damage.
- The anatomical proximity of the urethra to the genital tract and rectum.
- Due to the action of progesterone, the ureters dilate and their motor activity decreases, which reduces the rate of urine flow.
- Under the influence of progesterone, blood flow in the glomeruli of the kidneys slows down.
- The growing uterus puts pressure on the ureters. The right kidney is most often affected, which is apparently due to the attachment of most embryos in the right corner of the uterus. In 25% of cases, bilateral pyelonephritis is observed.
- Polyhydramnios, multiple pregnancies, large fetuses and an anatomically narrow pelvis are also risk factors.
- General suppression of the immune system during pregnancy contributes to the development of infectious diseases.
Symptoms of acute and chronic pyelonephritis
The clinical picture consists of three components:
- General symptoms - fever up to 39–40 °C, joint and muscle pain, nausea and vomiting. Body temperature rises and falls several times during the day, with fluctuations reaching 2 °C.
- The pain in the lumbar region and upper abdomen is aching, usually on one side. Unpleasant sensations intensify with deep inspiration and palpation of the abdomen.
- Urination disorder - excessive amount of urine, predominance of nighttime diuresis over daytime, frequent or painful urination.
A characteristic triad of symptoms helps to suspect pyelonephritis when you first visit a doctor before conducting diagnostic tests.
Chronic pyelonephritis is a condition in which inflammation in the kidney tissue does not disappear completely even in the absence of symptoms. Infectious agents remain in small quantities in the organ even when immunity decreases (hypothermia, malnutrition, stress, diabetes mellitus, pregnancy itself) make themselves felt again and again.
Chronic inflammation in the kidney can be either a consequence of an acute process or an independent disease. In the latter case, the symptoms are scant, little expressed, and patients do not know about their problem for a long time.
In this case, several cyclically repeating phases are distinguished:
- active phase - completely simulates the picture of an acute disease;
- partial remission - there are no symptoms of the disease, but typical changes in the urine remain;
- clinical and laboratory remission - urine tests also do not reveal any abnormalities.
According to the leading syndrome active phase There are several forms of chronic pyelonephritis:
- hypertensive - with increased blood pressure;
- anemic - with a decrease in hemoglobin levels;
- azotemic - with a change in the level of metabolic products in the blood.
If kidney damage has become chronic, even long-term clinical and laboratory remission does not mean complete recovery. Possibility of microorganisms for a long time to exist in the kidney tissue is determined by the genetic characteristics of the patient. This is also confirmed by the fact that mothers who suffered from pyelonephritis during pregnancy are significantly more likely to give birth to children with urological problems.
Diagnostic measures
To confirm the diagnosis, technically simple available studies are sufficient. To clarify and select the most rational treatment tactics, high-tech procedures may be required.
For all women with the described symptoms, a consultation (and for pregnant women, dynamic observation) of a gynecologist is required.
Differential diagnosis
Careful questioning, examination and examinations can distinguish pyelonephritis from other kidney diseases.
Thus, during lower urinary tract infections (urethritis, cystitis), the concentrating ability of the kidneys does not suffer, and leukocytes do not stick together into cylinders. There is no high fever with chills or profuse sweat.
Focal kidney damage (cyst, abscess, tumor) is excluded using ultrasound examination, computed tomography and angiography.
Isolated leukocyturia may be a manifestation of renal tuberculosis, which is confirmed or refuted by culture on special nutrient media.
For chronic glomerulonephritis edema and increased blood pressure are more typical, and in urine analysis - a predominance of red blood cells.
Treatment of pyelonephritis in pregnant women: medication and folk remedies
Acute pyelonephritis or exacerbation of chronic pyelonephritis in a pregnant woman requires immediate hospitalization and treatment in a hospital. For the entire period of fever, bed rest is prescribed, and then ward rest. The treatment position is recommended on the healthy side or in the knee-elbow position to improve the passage of urine through the ureters.
In addition, you need a diet with sufficient calories, as well as the exclusion of spicy foods, seasonings, rich broths, and coffee. In the absence of edema, fluid intake is not reduced.
Antibacterial therapy takes the leading place in the treatment of pyelonephritis.
Pregnant women have a very limited list of drugs used: tetracyclines are dangerous for the liver and skeletal system of the fetus, aminoglycosides are dangerous for the kidneys and hearing, chloramphenicol has a detrimental effect on the bone marrow. Sulfonamides, Erythromycin, Co-trimoxazole are prohibited. The listed threats also apply to women during lactation.
Drugs of the group of protected penicillins and cephalosporins are used, after 18–20 weeks - nalidixic acid. The course of treatment is 6–8 weeks with regular changes of the antibacterial drug. After successful completion of the main course, an anti-relapse regimen is prescribed: a monthly 10-day intake of antibiotics is replaced by a 20-day use of herbal remedies.
For example, 30 grams of dry bearberry leaves, 10 juniper berries pour cold water(500 ml), bring to a boil and leave to simmer for 5 minutes. Then the broth is wrapped in a towel for another 30 minutes. The product is taken orally, 100 ml three times a day.
If conservative therapy is ineffective, surgical treatment is prescribed - nephropyelostomy or puncture nephrostomy - urine removal through a special tube (bypassing natural ways) before birth. This allows you to reduce the pressure in the pyelocaliceal system and prevent damage to the glomerular apparatus. In case of frequent attacks of pyelonephritis, a ureteral stent is installed for several months to maintain the normal outflow of urine from the kidney.
IN complex treatment During the period of resolution of the disease, physical therapy is included:
- thermal procedures for the lumbar region (paraffin baths, mud baths);
- diathermy (warming the body with high frequency currents);
- balneotherapy (treatment with mineral waters);
- electrophoresis (exposure to electrical impulses).
Doctor Komarovsky about taking medications during pregnancy - video
Disease prevention
The best protection for a woman while expecting a child from infectious diseases is treatment of concomitant pathologies:
- carious teeth;
- ENT organs;
- reproductive system, etc.
For pregnant women, urine testing is required once every two weeks, and starting from the 20th week - weekly. Control of body weight and blood pressure is extremely important. Patients with a chronic course of the pathology are observed for life by a therapist once a quarter with the appointment of general clinical tests and urine culture. Twice a year - a biochemical blood test, once every 12 months - a detailed examination in a specialized hospital.
In addition, in such a situation, natural childbirth is preferable. The likelihood of inflammatory complications after caesarean section increases by 2 times, since during surgery it is possible to introduce an infection from the urinary system to the uterus.
Pyelonephritis, both during pregnancy and outside of it, is an insidious disease that requires early diagnosis and persistent treatment. The pathology is dangerous due to spontaneous abortion, illness and even death of the fetus, and in the long term - the formation of chronic renal failure requiring hemodialysis.
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In many cases, after pregnancy and childbirth, exacerbation of most chronic processes is possible. The huge load on all systems and organs cannot go unnoticed, so a very significant percentage of women after childbirth turn to specialists with various pathologies. One of these problems is the diagnosis and treatment of pyelonephritis in the postpartum period.
What signs are characteristic of of this disease and how to treat the patient? There are more and more questions related to this disease and the behavior of a nursing mother during this period. We will try to tell you in as much detail as possible about what is possible and what experts categorically do not recommend doing. Pyelonephritis is an inflammatory disease in which damage to the pyelocaliceal system is noted.
Pyelonephritis and its symptoms
Often, after a woman returns from the maternity hospital and immerses herself in household chores, a pathological condition is noted, which is characterized by several non-specific signs.
- Chills
- Muscle aches or pain
- Temperature increase: sharp and up to 38-390 C
- Urine loses clarity and becomes cloudy
- Severe or moderate pain in the lumbar region
- Painful sensations can also be localized in the lower abdomen, thighs, or less commonly in the genitals.
All signs appear in a short time and a young mother is not always able to adequately assess her condition. Pain in the lumbar region, as a rule, becomes the last straw, after which the woman turns to a specialist.
Based on a urine test, as well as a number of laboratory tests, the doctor diagnoses pyelonephritis; in addition, the sensitivity of the pathogen to several types of antibiotics is immediately determined. This is necessary for the appointment of the maximum effective remedy capable of coping with the pathological process.
Based on the results of the examination, the doctor makes a diagnosis. In most cases, the cause of this condition is pyelonephritis during the postpartum period. It is strictly not recommended to take any medications before consulting a doctor. Uncontrolled use of antibiotics, painkillers or antipyretics greatly complicates the work of a specialist. It becomes much more difficult for a doctor to diagnose left-sided pyelonephritis or another form of pathology. If cystitis was treated during breastfeeding before treatment, the clinical picture will be blurred. You definitely need to tell your doctor about all the pathologies that have appeared recently.
What should be done in this case and what should be the treatment for acute pyelonephritis in a nursing mother? Some women prefer to wait to treat the disease until the baby weans the breast, for fear of harming the young body. Is this approach reasonable? Is it possible to treat pyelonephritis with breastfeeding? Experts unequivocally say: it is not only possible to treat the disease, but also necessary! But how and with what - this must be decided by the doctor in each specific case, based on the symptoms and severity of the disease.
Chronic and acute forms of the disease
In most cases, symptoms after childbirth appear after a short period of time. This is due to the fact that the body, weakened by insomnia and labor, is not able to fully fight infectious agents. Streptococci and Proteus, Enterococci and Escherichia cause all unpleasant symptoms diseases.
Experts distinguish two main forms of pyelonephritis:
- Spicy. It manifests itself if the pathological process is just developing and the woman has not previously suffered from pyelonephritis.
- Chronic. If before pregnancy a woman suffered from pyelonephritis and the inflammatory process remained untreated, then after childbirth an exacerbation and return of all symptoms is possible.
Basic principles of treatment
If a woman has the first signs of pyelonephritis, she should immediately seek advice from a specialist who can correctly and promptly diagnose the pathological condition, and then prescribe appropriate treatment. In most cases, the doctor will insist on hospitalization. This decision is not without meaning, because in a hospital setting it is much easier to control the dynamics of the patient’s condition and it is possible to use a complex of the most effective medicines.
However, postpartum pyelonephritis in a nursing mother is complicated by the woman’s reluctance to be separated from the baby and interrupt breastfeeding. In this case, the doctor is forced to decide on hospitalization of the woman in the event of a sharp deterioration in the patient’s condition or prescribe appropriate medications that can be used at home.
How to treat pyelonephritis? Of course, antibiotics will be the basis of the therapeutic complex. And on this basis many questions arise.
Antibiotics and breastfeeding
So, how to treat pyelonephritis of both kidneys during breastfeeding? The answer from a competent and qualified specialist will be unequivocal: antibiotics. After all, the pathological process can affect not only the pelvis and tubules, but also affect the entire kidney.
The worries of many mothers associated with the prescription of antibiotics are often not without meaning. Depending on the severity of the disease, the doctor prescribes medications that may not be compatible with breastfeeding. However, this is not a reason to refuse treatment. The baby needs to be transferred to artificial feeding, and the mother should follow the specialist’s instructions flawlessly.
This video explains how to combine medication and breastfeeding without harming the baby:
A nursing mother will have to work hard to maintain lactation. You will have to express milk several times a day (6-9). The main antibacterial drugs that are most effective during this period include Amoxicillin. Doctors immediately warn that its use has negative impact for the baby. Nevertheless, Amoxicillin very effectively fights the causes of the disease, and therefore is widely popular among many specialists.
But the latest generations of antibiotics act selectively, so there is a high probability that a nursing mother will be treated without recommendations to stop breastfeeding. The annotations of many modern drugs indicate that they can be used during breastfeeding or lactation. In this case, you don’t have to worry about the fact that antibiotics threaten the baby and can cause any negative consequences. However, not all of them will be effective; in any case, the choice of drug for therapy will be strictly individual and based on the severity of the patient’s condition.
How to treat pyelonephritis besides using antibacterial drugs? Experts recommend drinking plenty of warm drinks to help remove toxins and waste products from the body. Also an important factor Bed rest will promote recovery. Only full compliance with all the doctor’s recommendations will be the key to a complete recovery and a return to full breastfeeding of the baby.
Pyelonephritis is acute or chronic inflammation of the kidneys. In most cases main role Bacteria – E. coli, strepto- and staphylococci – play a role in the development of the disease. Pyelonephritis may practically not bother a woman before pregnancy, since a “healthy balance” will maintain immunity.
During pregnancy and after childbirth, young mothers often have to “remember” this disease, which returns at the most inopportune moment. What symptoms should you pay attention to and how to treat pyelonephritis during lactation?
Read in this article
Why do your kidneys hurt when breastfeeding?
Kidneys are an important organ in the human body. Its main function is to filter the blood in special glomeruli, cleansing it of toxins. In a few minutes, the kidneys pass through their entire volume. Disruption of this organ leads to serious changes throughout the body. Therefore, it is extremely important to promptly identify and treat renal pathology.
Unpleasant sensations and discomfort may appear when swelling of the tissue under the capsule occurs or the urinary tract is irritated, for example, by salt crystals, etc.
This may be caused by the following conditions:
- Inflammation of all organ structures – pyelonephritis. In this case, swelling of the perinephric tissue occurs, which causes nagging pain in the back.
- Urolithiasis. Pain in this case occurs due to the fact that small stones begin to move along the renal pelvis and ureters, causing irritation of the mucous membrane and severe pain.
- Thrombosis of renal vessels. In this case, swelling of the kidney occurs due to the fact that blood flows in, but its outflow is impaired due to vascular thrombosis. This happens extremely rarely after childbirth.
- Glomeluronephritis– disruption of kidney function due to changes in glomeruli - glomeruli.
- Hydronephrosis– accumulation of fluid in the pelvis if the outflow of urine is disrupted, for example, with urolithiasis, with a tumor. Stretching of the kidney capsule causes pain.
- Injuries, bruises in the lumbar region.
But it should be noted that most often pain in the lumbar region is caused not by kidney pathology, but by problems with the spine (osteochondrosis) and muscles (myositis).
The following conditions do not lead to severe pain:
- benign (cysts, etc.) and malignant tumors in the early stages;
- acute or chronic renal failure;
- malformations of this organ.
When renal pathology is confirmed after childbirth, in more than 90% of cases it is pyelonephritis. This is due to the fact that during this period the woman’s immunity is significantly weakened. And sometimes a young mother does not even suspect that she has a hidden infection in her kidneys. Accordingly, against the background of weakened immunity, microbes begin to become more active and cause illness. It can begin to appear either immediately after childbirth or after a few weeks.
Symptoms of pyelonephritis during lactation
During pregnancy and after childbirth, urinary tract infections (UTIs) are common. This condition is not accompanied by any symptoms; the pathology is diagnosed by inflammatory changes in urine tests. If a UTI is missed, the infection will progress to pyelonephritis. Therefore, it is important to regularly take at least general urine tests during pregnancy and for some time after childbirth.
Pyelonephritis can occur in acute and chronic form. The course of the disease largely determines the severity of symptoms. Accordingly, acute pyelonephritis will have a bright clinical picture, while chronic – erased. Symptoms of the disease include the following:
- , most often up to 38 and above. This is due to intoxication of the body and activation of infection.
- Along with this, weakness, lethargy, and headaches appear.
- There may be digestive disorders - nausea or vomiting.
- The main symptom is pain in the area of the projection of the kidneys. Usually this is in the lumbar region or a little higher, almost under the very ribs on the back. The pain can be sharp and unbearable, but more often it is a dull and aching discomfort.
- Often pyelonephritis is accompanied by involvement of other parts of the urinary system in the inflammatory process ( bladder, urethra, etc.). This will add symptoms such as pain and cramps when urinating, frequent urges, and others.
Forms of pyelonephritis and their features
Depending on the clinical manifestation and course of the disease, there are two forms of pyelonephritis - acute and chronic. Each of them has its own treatment principles and prognosis.
Acute
The acute form always begins suddenly, usually with an increase in body temperature. All other clinical symptoms are also pronounced, so there are no special problems in diagnosing the condition. But acute pyelonephritis requires serious treatment, despite breastfeeding. Sometimes you have to resort to surgery, for example, installing stands in the ureters to normalize the outflow of urine, etc.
Acute pyelonephritis can lead to different types complications, for example, the formation of multiple abscesses in the kidney (apostematous nephritis) or an abscess.
Chronic
Chronic pyelonephritis can form for several reasons. Namely:
- If antibacterial drugs are taken incorrectly (incomplete regimens, incorrect doses, etc.). This leads to the development of drug resistance in bacteria.
- With a weak immune response to inflammation, some of the microbes eventually enter a latent form.
- If there are any structural features of the organs of the urinary system. They can be congenital or acquired (after operations, injuries, etc.).
Chronic pyelonephritis can occur with rare periods of exacerbation. In this case, the woman has no idea about the source of latent infection in her body for a long time. Any weakening of the immune system (childbirth, pregnancy, etc.) leads to the activation of microbes.
A long course of chronic pyelonephritis can lead to shrinkage of the kidney, it decreases in size and ceases to function. The risks of urolithiasis, hydronephrosis, kidney failure and other problems also increase.
Watch the video about pyelonephritis:
Is it possible to relieve kidney pain at home?
Determine independently whether you are worried about at the moment kidneys or something else is quite difficult. Therefore, if you experience acute back pain, it is better to seek medical help, especially if your body temperature rises or there are other alarming symptoms. If the discomfort is tolerable, a nursing mother can try taking the following medications before going to the doctor:
- Antispasmodic drug, for example, Drotaverine, Papaverine. They are safe for the baby in the usual dose.
- Additionally, you can take NSAIDs, for example, Ketonov and others.
- Antipyretics for high temperatures.
- As a last resort, you can start taking an antibiotic, but it is better to do this as prescribed by a doctor.
Diagnosis of the disease
A doctor may suspect pyelonephritis based on complaints, examination and medical history. To clarify and determine the extent of the process, a more in-depth examination is necessary. Urine is thoroughly analyzed. The following tests are performed with it:
Type of study Features of the event General research With pyelonephritis, the TAM will have increased leukocytes, protein, possibly casts and bacteria. Bacteriological culture of urine for flora It is important to do this test before starting antibiotics. Otherwise, the results may not reflect the true process. Urine according to Nechiporenko Gives a more detailed result on the content of leukocytes. Research on Zimnitsky It is carried out to identify kidney dysfunctions, which may be the first signals on the path to renal failure. Three-glass sample It is carried out to determine the location of inflammation (kidneys, bladder or urethra). In this case, it is necessary to collect urine sequentially into three containers during one act of urination. Instrumental diagnostic methods are used. Most often this is:
- Ultrasound examination of the kidneys. In this case, you can see signs of inflammation, an increase in size, accumulation of fluid in the pelvis and ureters, etc.
- X-ray methods are widely used - various types of urography and others. In this case, the urinary system is filled with a contrast agent and a series of images is taken. They can be used to judge some serious changes in the kidneys.
- CT and MRI are often performed in case of tumor processes or suspicion of them.
Treatment of pyelonephritis with hepatitis B
Treatment of pyelonephritis, both acute and chronic, is always complex. The most rational and safe medications during breastfeeding can only be prescribed by a specialist. Self-medication with seemingly harmless means can only worsen the situation.
Typically, treatment for pyelonephritis includes the following:
- medicines,
- herbal medicine,
- physiotherapy.
Drug therapy
During breastfeeding, it is advisable to use a minimum of funds. The mandatory list includes the following:
- Antibiotics. It is ideal to select them taking into account the sensitivity of the flora, but this is not always possible. The most commonly used antibiotics are the cephalosporin group (Cefepime, Cefuroxime, Cefotaxime and others), penicillins (Amoclav, Amoxiclav, etc.).
- If necessary, use painkillers, antispasmodics and the like.
During treatment, the main thing is to maintain a drinking regime (if necessary, infusions of physiological solutions are carried out) and not create obstacles to the outflow of urine. For the latter, it is recommended not to sleep on the sore side, take the knee-elbow position several times a day, and avoid constipation.
You should also limit table salt in the diet, as it will contribute to the retention of excess fluid.
Folk remedies
For the treatment and prevention of pyelonephritis, preparations with a mild diuretic, as well as antiseptic and antimicrobial effect are used. These can be complex compositions or single-component ones. It is recommended to prepare infusions, decoctions, teas, fruit drinks from the following plants:
- bearberry, chamomile,
- cranberry, lingonberry,
- parsley, dill, fennel,
- rosehip, etc.
Many of these herbs will also be beneficial for the baby when taken by the mother during lactation. But you still need to be vigilant and monitor the baby’s reaction to each new component.
Physiotherapeutic treatment
Used after the acute period has passed and the temperature has returned to normal. Magnetic therapy, UHF on the kidney area, paraffin baths, electrophoresis with drugs, medicinal baths, microwave, laser therapy and others are effective.
Prevention of pyelonephritis during breastfeeding
Girls who have had kidney problems or UTIs ever or during pregnancy have a greater risk of developing pyelonephritis immediately after childbirth or some time after. Therefore, this category needs to be especially careful about preventing the disease. It includes the following:
- You should try to avoid hypothermia.
- You can take courses of herbal remedies.
- Immediately after birth, a week and a month later you should take the general analysis urine.
- You need to drink at least 2 liters of water per day.
Pyelonephritis often worsens after childbirth. Modern medications allow a woman not to interrupt breastfeeding and effectively treat kidney inflammation. Risk groups should prevent the development of the disease, this way you can avoid not only exacerbation, but also the unpleasant consequences of chronic infection in the future.
In the practice of medical specialists, situations are often encountered when a nursing woman develops an infectious and inflammatory lesion of the urinary system. As a rule, the cause of this condition is pathogenic microorganisms of a bacterial nature that enter the body of a young mother through an ascending route.
The increased tendency of pregnant and lactating women to develop infectious and inflammatory diseases is due to the depressed state of the immune system. The development of pyelonephritis can cause great damage to the mother’s body and lead to the formation of more serious pathologies genitourinary system. Complications can only be prevented by making a reliable diagnosis and completing the full course of drug therapy.
Reasons
The following unfavorable factors can provoke acute inflammation of the renal apparatus in nursing women:
- Increased psycho-emotional and physical stress on the body of a young mother;
- Physiological inhibition of the body’s defenses associated with the process of bearing a child;
- Hormonal changes in the female body;
- Activation of pathogenic or conditionally pathogenic microflora against the background of immunodeficiency;
- Wearing tight underwear made of synthetic fabric.
The most common causative agent of pyelonephritis is Escherichia coli, which penetrates the renal apparatus of a nursing woman ascendingly through the ureters.
Symptoms
The formation of an infectious-inflammatory lesion of the renal apparatus can be recognized by a number of characteristic signs:
- Weakness and general malaise;
- Body aches;
- A sharp increase in body temperature to 38-39.5 degrees;
- Pain and discomfort in the lumbar region;
- Urine becomes cloudy in color.
Often, pain syndrome with pyelonephritis extends to the area of the inner thighs, lower abdomen and perineum. During the formation of infectious inflammatory process a woman may be bothered by a frequent urge to urinate, which is accompanied by discomfort.
Diagnostics
The diagnosis of infectious and inflammatory damage to the renal apparatus is made based on the results of laboratory and instrumental studies. To diagnose pyelonephritis in nursing women, the following methods are used:
- General clinical blood test, which allows you to determine such markers of the inflammatory process as accelerated ESR and leukocytosis;
- General clinical and bacteriological analysis of urine, the purpose of which is to detect leukocytes in the urine, as well as to isolate pathogenic microorganisms that provoke an inflammatory reaction in the body;
- Ultrasound examination of the kidneys;
- Determination of the sensitivity of bacterial microorganisms to certain groups of antibiotics.
Based on the results of the medical examination, the young mother is given an appropriate diagnosis and drug therapy is prescribed.
Treatment
Treatment of acute pyelonephritis in nursing women should be carried out under the strict guidance of the attending physician. If a young mother is faced with signs of an infectious-inflammatory lesion of the renal apparatus, then until she visits a medical specialist, she can resort to independent measures to relieve pain and discomfort. Such measures include:
- To relieve spasms, antispasmodic drugs such as Papaverine or Drotaverine are used. These medications do not pose a danger to the body of the woman herself and the baby who consumes breast milk;
- Help cope with pain syndrome such analgesics as Ketanov and Paracetamol will be able to;
- When body temperature increases above 38 degrees, Ibuprofen or Paracetamol is used as an antipyretic. These medicinal drugs from the group of non-steroidal anti-inflammatory drugs do not expose the child’s body to the risk of negative consequences.
Carry out independent selection of names and dosages of antibacterial medicines is strictly prohibited, since many of them are able to enter the baby’s body through mother’s milk, causing a toxic effect.
At an appointment with a medical specialist, a nursing woman is prescribed drug therapy, including the following groups of drugs:
- Painkillers (analgesics);
- Antispasmodics;
- Antibacterial drugs. Women during breastfeeding are most often prescribed drugs such as Amoxiclav, Cefuroxime, Amoclav and Cefepime.
An important condition for the treatment of pyelonephritis in nursing women is compliance. This event allows you to promptly cleanse the urinary tract from waste products of pathogenic microorganisms. In addition, a nursing patient is advised to refrain from sleeping on the right or left side (depending on the side of the location of the inflamed kidney). Additional recommendations include:
- Prevention of constipation;
- Stay in the knee-elbow position every day for 5-10 minutes;
- Wearing loose underwear made from natural fabrics;
- Use mineral water, berry fruit drinks without added sugar, fruit juices and compotes;
- Throughout the entire treatment period, a nursing mother must take care to prevent hypothermia.
As an effective addition to drug therapy for infectious and inflammatory damage to the renal apparatus, a nursing mother should prepare decoctions of medicinal herbs that have antimicrobial, diuretic, antiseptic and anti-inflammatory effects.
For the treatment of pyelonephritis in nursing women, the following herbal components are indicated:
- Fennel, dill and parsley seeds;
- Chamomile and bearberry flowers;
- Fruits;
- Lingonberries and cranberries.
Hardware physiotherapy techniques are used to treat pyelonephritis after the acute period has subsided and body temperature has normalized. To treat the inflammatory process, paraffin baths, magnetic therapy, microwave, laser therapy, as well as electrophoresis using medicinal drugs are used.
To avoid a hidden course of the inflammatory process, every young mother needs to undergo a laboratory urine test a week after discharge from the maternity hospital.
This is a bacterial infection of the renal parenchyma. may occur in the postpartum period if the bacterial infection is ascending from the bladder. The infection may present as asymptomatic bacteriuria during pregnancy and is sometimes associated with bladder catheterization to reduce bladder distension during labor and postpartum. The most common pathogenic organisms are bacteria belonging to the intestinal group (for example, Escherichia co). Symptoms of pyelonephritis include fever, associated pain, general malaise, and sometimes painful urination.
Initial treatment of pyelonephritis after pregnancy is as follows: ceftriaxone 1-2 g intravenously every 12-24 hours or ampicillin 1 g intravenously every 6 hours in combination with gentamicin 1.5 mg/kg intravenously every 8 hours for 48 hours in the absence of fever in the woman. It is necessary to conduct a urine culture test to determine sensitivity to antibiotics. The total duration of treatment is 7-14 days; Oral antibiotics are used after the initial use of intravenous antibiotics. Women need good care and plenty of fluid intake. It is necessary to conduct a repeated bacteriological examination of urine 6-8 weeks after birth to confirm cure. All women with recurrent pyelonephritis during pregnancy or after childbirth should undergo contrast imaging to confirm or rule out stones or congenital malformations.
Complications from the mother with pyelonephritis
The most common maternal complications include breast engorgement, cracked nipples, blocked milk ducts, and restlessness.
Breast engorgement, which occurs early in lactation and lasts 24-48 hours, can be minimized by early, frequent breastfeeding. A comfortable bra for nursing mothers that should be worn 24 hours a day, as well as a cool compress on the breasts after feeding, and the use of a mild analgesic (for example, ibuprofen) can also help. A breastfeeding woman may also need a massage and a warm compress. If you express a little milk before feeding, this will allow the baby to better grasp the swollen areola with his mouth. Additional pumping of milk between feedings reduces engorgement; you do not need to express all the milk, but just enough to relieve discomfort.
For the treatment of cracked nipples it is necessary to check the baby’s position during feeding; Sometimes babies pull their lip in and suck on it, which irritates the nipple. A woman can release her lip with her thumb. After feeding, squeeze out a few drops of milk and let them dry on the nipple. After feeding, a cool compress will reduce engorgement and provide continued comfort.
Blocked milk ducts appear as a tense, moderately painful area of the breast of a nursing woman, while she does not have general signs of the disease. Seals occur in different places, they are painless. Continuing breastfeeding will ensure that the breasts empty. Warm compresses and massage of the affected segment can help restore patency. Also, a woman can change her position when feeding, because different areas The mammary glands are better emptied depending on the position of the child. A comfortable bra can help, while regular bras with wire inserts and compression straps can cause milk to stagnate in tight areas.
It occurs quite often and manifests itself as a painful, hot, swollen wedge-shaped area of the mammary gland. It develops against the background of engorgement of the mammary gland, blockage of the ducts; infection can occur secondarily, most often caused by penicillin-resistant strains of Staphylococcus aureus, less often by Streptococcus sp or Escherichia coli. When infected, fever (> 38.5°C), chills, and a flu-like condition may develop. The diagnosis of pyelonephritis is based on history and clinical data. Cell counts (white blood cells > 10 6 /ml) and breast milk cultures (bacteria > 10 3 /ml) will help distinguish infectious from non-infectious mastitis. If symptoms are mild and last less than 24 hours, it may be sufficient conservative treatment(emptying the breast during feeding or by pumping, compresses, analgesics, support bra, protective regimen). If improvement does not occur after 12-24 hours or the activity of the process is high, it is necessary to begin antibacterial therapy using drugs that are safe for the child and effective against S. aureus (for example, cephalexin 500 mg orally 4 times a day); Duration of therapy is 10-14 days. Complications of late initiation of therapy are relapse and abscess formation. You can continue breastfeeding during treatment.
Mother's Worry, frustration, and feelings of dissatisfaction may develop due to lack of breastfeeding experience, mechanical difficulties during feeding, fatigue and difficulty determining the sufficiency of milk, as well as postpartum physiological changes. These factors and emotions are the most common reasons why women stop breastfeeding. Early observation by a pediatrician or consultation with a lactation specialist are effective measures to prevent early cessation of breastfeeding.
Medicines. Breastfeeding women should avoid taking medications if possible after pregnancy. If drug therapy is necessary, many drugs should be avoided, as well as drugs that suppress lactation (bromocriptine, levodopa), you should choose the safest alternative drug and take it immediately after breastfeeding or before the baby's longest sleep period; This method is less applicable for newborns who eat frequently and whose feeding schedule has not yet been established. Data on the adverse effects of most drugs come from case reports or small studies. Some drugs (eg, acetaminophen, ibuprofen, cephalosporins, insulin) have been shown to be safe in extensive studies, while others are considered safe only based on no reports of adverse effects. Medicines that have been used for a long time are generally safer than new drugs, the information about which is limited due to little experience with their use.
Weaning. As a rule, weaning occurs by mutual consent of mother and child at any age over 12 months. More often, cessation of breastfeeding occurs gradually over several weeks or months, while the baby is offered new types of solid foods; Some babies wean straight away without any problems, while others maintain 1-2 breastfeedings per day for up to 18-24 months or even longer.
